| NPI | 1811951478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36-00-3391) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36-00-3391) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: OH 36-00-3391) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2012-09-28 |