| NPI | 1437779766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: NY 007334-01) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 007334-01) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 213ER0200X Podiatrist, Radiology (Licence: NY 007334-01) | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-09-18 |