| NPI | 1174929442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4431) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003898) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2023-12-11 |