| NPI | 1295112738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2316) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 59.000569) |
| 213E00000X Podiatrist (Licence: TX 2316) | |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2022-04-19 |