| NPI | 1114923398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36003056W) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: OH 36003056W) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36003056W) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2021-04-21 |