| NPI | 1760855852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WV 10455) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 59.000578) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2022-04-06 |