| NPI | 1881058220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003897) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 00000000000000000000) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2019-06-03 |