| NPI | 1235480310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: HI PO-216) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E5149) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2021-06-15 |