| NPI | 1598765810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 10385) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC005625) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 10385) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-11-07 |