| NPI | 1760836506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36.003923) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36.003923) |
| 213E00000X Podiatrist (Licence: OH 36.003894) | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2023-06-20 |