| NPI | 1275194813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 007268) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NY 007268) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 007268) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2023-02-13 |