| NPI | 1326247354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36003704) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4515) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2014-06-12 |