| NPI | 1063416956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36 002126) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: OH 36 002126) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36 002126) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2007-10-30 |