NPI | 1497217020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 3147) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2019-04-02 |
Last Update Date | 2022-08-24 |