| NPI | 1407207061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.003867) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003867) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2021-06-02 |