| NPI | 1558363721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36002777) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002777) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2011-10-06 |