| NPI | 1740668839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 268170) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36.003878) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36.003878) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2021-06-25 |