| NPI | 1013605559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: ND 96) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2026-07-22 |