| NPI | 1114915931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36-00-2836-G) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36-0002836) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2020-04-17 |