| NPI | 1841810017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CO POD.0000944) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301399) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2024-07-15 |