| NPI | 1144962549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM T-22101) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NM RESIDENT) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2023-10-31 |