| NPI | 1477173524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 007336) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135.001087) | |
| Enumeration Date | 2020-04-19 |
| Last Update Date | 2023-07-19 |