| NPI | 1205899887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36002311) |
| Additional Taxonomies | 213ES0131X (Licence: OH 36002311) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2016-09-09 |