| NPI | 1144782517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00369600) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 59.000773) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2022-08-19 |