| NPI | 1437824216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI S5200019602108) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2022-05-09 |