| NPI | 1336602556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 3151) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213E00000X Podiatrist (Licence: TX 3151) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4240) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: TX 3151) | |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2022-07-26 |