| NPI | 1457328320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 983-25) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002976) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2010-12-17 |