| NPI | 1255687885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: LA 303434) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301232) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX t60-2012) | |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2022-08-02 |