| NPI | 1063412401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 238) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36002849W) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC0031702) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2008-06-03 |