| NPI | 1427013093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC 730) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002462) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2022-09-29 |