| NPI | 1609027689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36003576) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 7054576-0501) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2011-07-26 |