| NPI | 1316473721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36.004094) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WV 10475) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2024-08-13 |