| NPI | 1710306881 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 2272) | 
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003775) | 
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2272) | |
| Enumeration Date | 2014-04-15 | 
| Last Update Date | 2025-08-09 |