| NPI | 1902954613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3418) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 35498) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-11-21 |