| NPI | 1659113199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM PRS2024-0005) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM prs2024-0005) |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2025-12-07 |