| NPI | 1295314268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.004134) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 59.000886) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-03-14 |