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 |