NPI | 1013597863 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 59.000890) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36.004137) |
Enumeration Date | 2021-04-14 |
Last Update Date | 2024-06-12 |