| NPI | 1124888151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONAH GROOVER Podiatry Resident 817-201-0323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-03-19 |