| NPI | 1144714296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NV 2077) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 11354714-0501) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2022-08-03 |