| NPI | 1700178035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36.003706) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 1030) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2023-12-19 |