| NPI | 1780733378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.002229) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002229) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-01-08 |