| NPI | 1649432998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00298100) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY 006280) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2011-06-21 |