| NPI | 1871523548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E2383) |
| Additional Taxonomies | 213ES0131X (Licence: CA E2383) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-02-15 |