| NPI | 1891792115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.00-3061) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 362) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2011-08-08 |