| NPI | 1972161016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001470A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5951001345) |
| 213E00000X Podiatrist (Licence: MI 5315210168) | |
| 213E00000X Podiatrist (Licence: MI 1972161016) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2024-07-25 |