| NPI | 1821094970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3961) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC26437) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2025-09-11 |