| NPI | 1013595107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.004128) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 213E00000X Podiatrist (Licence: OH 36.004128) | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-09-30 |