| NPI | 1215370093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 2429) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 1308) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2016-05-23 |