| NPI | 1790120681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2193) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 2193) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2021-03-05 |