| NPI | 1952543886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E3770) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 15317) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2009-03-24 |