| NPI | 1083606974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36003149) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00258) |
| 213E00000X Podiatrist (Licence: KY 244160) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2024-05-07 |