| NPI | 1376544148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36002459) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MI 1135) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL 1568) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2010-09-28 |