| NPI | 1780648345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001278) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36-00-2221) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: OH 36-00-2221) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36-00-2221) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2015-07-16 |