| NPI | 1043217813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36-00-2979) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 353) |
| 213E00000X Podiatrist (Licence: PA SC-00-4569) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2019-02-21 |