| NPI | 1386170777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NM POD442) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO PDT.0000564) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO PDT.0000564) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2022-02-18 |