| NPI | 1780650812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.003433) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36.003433) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2011-09-28 |