| NPI | 1346091824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 000000000) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 000000000) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-06-24 |