| NPI | 1740501477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N006481) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N0064811) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2021-10-12 |