| NPI | 1336254713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 841-25) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003567) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2012-05-18 |