| NPI | 1306588165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 007465) |
| Additional Taxonomies | 211D00000X Assistant, Podiatric |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2025-07-02 |