| NPI | 1679969364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 376) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ POD-000905) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2021-01-22 |