| NPI | 1073049458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 12160807-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO PDT.0000563) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM POD432) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO PDT.0000563) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2023-03-29 |