| NPI | 1922451921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 10383567-0501) |
| Additional Taxonomies | 211D00000X Assistant, Podiatric |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: UT 10383567-0501) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2023-03-30 |