| NPI | 1477996155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 660) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 1305) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2021-12-17 |