| NPI | 1861021339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AR 304) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 00000000000) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-07-20 |