| NPI | 1285657460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36003211) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 00376) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-05-07 |