| NPI | 1558776450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 692307) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P121104) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2026-07-08 |