| NPI | 1912095324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 2842) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07000818) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-10-22 |