| NPI | 1164749859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36003664) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36003664) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36003664) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2021-06-15 |