| NPI | 1114413416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00351400) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA SC006956) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2022-09-07 |