| NPI | 1457520272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: OH CPED 2341) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: OH 36-002194) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36-002194) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2012-04-11 |