| NPI | 1689841363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36003453) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001059A) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2018-07-12 |