| NPI | 1184614075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP0504X Podiatrist, Public Medicine (Licence: OH 36001919R) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36001919R) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2011-10-19 |