| NPI | 1932725116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 798) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC TR-157) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2023-08-07 |