| NPI | 1174264881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X (Licence: PA SC007601) |
| Additional Taxonomies | 211D00000X Assistant, Podiatric |
| 213E00000X Podiatrist (Licence: PA SC007601) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007601) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-07-14 |