| NPI | 1669479044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36-00-2905) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC-00-4402) |
| 213E00000X Podiatrist (Licence: WV 330) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2019-02-21 |