| NPI | 1588403158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM PRS2024-0003) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM PRS2024-0003) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2025-10-28 |