| NPI | 1992238943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ID P256) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 12611167-0501) |
| 213E00000X Podiatrist (Licence: OR DP209154) | |
| 213E00000X Podiatrist (Licence: OK 363) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2023-03-27 |