| NPI | 1619617404 |
|---|---|
| Former Name | AUSTIN REID FOGLE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10082772) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2023-07-04 |