| NPI | 1144217993 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.002878) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 00336002878K) |
| 213E00000X Podiatrist (Licence: WV 00310) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2022-03-22 |