| NPI | 1366553919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36 002487) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36 002487) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36 002487) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |