| NPI | 1417307927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N007006) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N007006) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NY N007006) | |
| 261QP1100X Clinic/Center, Podiatric (Licence: NY N007006) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2023-07-25 |