| NPI | 1871026286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP202571) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO61122479) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2021-06-03 |