| NPI | 1790476570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007632) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007632) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2026-06-05 |