| NPI | 1487131108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4319) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PR580) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2021-07-27 |