| NPI | 1710306881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 2272) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003775) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-02-23 |