NPI | 1275023541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 769) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2018-05-13 |
Last Update Date | 2022-01-20 |