| NPI | 1780645267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36001550G) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36001550G) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2008-03-22 |