| NPI | 1508558602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007381) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2026-02-20 |