| NPI | 1194259341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 771) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 703) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: SC 703) | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2021-12-09 |