| NPI | 1275540130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4809) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36-003339) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2017-08-07 |