| NPI | 1619322955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NJ 25MD00352300) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 006885) |
| 213E00000X Podiatrist (Licence: NJ 25MD00352300) | |
| 213EP0504X Podiatrist Public Medicine (Licence: NJ 25MD00352300) | |
| 213EP0504X Podiatrist Public Medicine (Licence: NY 006885) | |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY 006885) | |
| 213ER0200X Podiatrist Radiology (Licence: NJ 25MD00352300) | |
| 213ER0200X Podiatrist Radiology (Licence: NY 006885) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: NJ 25MD00352300) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: NY 006885) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00352300) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY 006885) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: NJ 25MD00352300) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: NY 006885) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-24 |
| Last Update Date | 2023-09-08 |