| NPI | 1063974012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR DP209583) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH TBD) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2023-08-03 |