NPI | 1306104724 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003732) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36.003732) |
Enumeration Date | 2012-04-24 |
Last Update Date | 2015-07-20 |