| NPI | 1518080811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36003456) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 30003456) |
| 213ER0200X Podiatrist, Radiology (Licence: OH 36003456) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2022-04-05 |