| NPI | 1821084625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36003129S) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC005955) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2008-07-23 |