| NPI | 1588903058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.003726) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00428) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY P80992) | |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2022-06-23 |