| NPI | 1699344168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4677) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301419) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-08-28 |