| NPI | 1912262734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N006635) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00342000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2021-03-05 |