| NPI | 1700987096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WV 287) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36002364) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-12-19 |