| NPI | 1326453010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36.003854) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36.003854) |
| Enumeration Date | 2014-06-22 |
| Last Update Date | 2018-08-13 |