| NPI | 1760045447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PO4481) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA PDL1528) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2023-06-03 |