| NPI | 1508106345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36.003743) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006393) |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2016-07-18 |