| NPI | 1215433412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00360800) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00360800) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2021-06-08 |