| NPI | 1669419826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003431) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003431) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 36.003431) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2023-11-03 |