| NPI | 1619930922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36002755M) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002755) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2013-01-30 |