| NPI | 1629395405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00439) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD001206) | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2015-10-16 |