| NPI | 1659373496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: OH 36-00-2252-V) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OH 36-00-2252-V) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2011-10-31 |