NPI | 1417417064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901400479) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135.001040) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-03-20 |
Last Update Date | 2023-08-03 |