| NPI | 1801545512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 868) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NC 868) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2025-09-25 |