| NPI | 1760010615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ID P-287) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: ID P-287) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2023-06-07 |