| NPI | 1750733119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2394) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2398) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA SC006749) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-02-08 |