| NPI | 1063401727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36-00-2220-L) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: OH 36-00-2220-L) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2009-11-23 |