| NPI | 1316325590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 10722129-0501) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 1340) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2018-08-07 |