| NPI | 1033739735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X (Licence: TX 692178) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 692178) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2024-11-15 |