| NPI | 1710623236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007532) |
| Enumeration Date | 2022-05-08 |
| Last Update Date | 2025-07-02 |