| NPI | 1376231134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM PRS2024-0004) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM Prs2024-0004) | |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2026-02-26 |