Individual
AHRA CHO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
DPM
Contact information
Practice address
550 1ST AVE., NEW YORK, NY 10016-6402
(212) 263-5506
Mailing address
550 1ST AVE., NEW YORK, NY 10016
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/12/2025
Last updated
04/12/2025
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