| NPI | 1508387549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 3037) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX T50-2017) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2024-10-17 |