| NPI | 1346603859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 1175) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4046) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2024-04-18 |