| NPI | 1720514078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4512) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006866) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2023-09-19 |