| NPI | 1124050612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: OH 35.130646CTR) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003114G) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36003114G) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-01-11 |