| NPI | 1891180816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AZ 000978) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MO 2018017440) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: KS 12-00444) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2022-02-09 |