| NPI | 1205571825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692216) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 692216) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2025-06-11 |