| NPI | 1982227567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IN 07001424A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 59.000863) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-09-29 |