| NPI | 1366855298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001293A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006420) |
| 213E00000X Podiatrist (Licence: KY 243941) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2024-02-14 |