| NPI | 1811348808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5515) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00453) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2021-06-28 |