| NPI | 1245898279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E6197) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NM POD473) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2026-08-18 |