| NPI | 1457791865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO3771) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PR327) |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2020-09-30 |