| NPI | 1558868950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5934) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN 906) |
| 213E00000X Podiatrist (Licence: KY 270847) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-05-25 |