| NPI | 1912967381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36-003338) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901001812) |
| 213E00000X Podiatrist (Licence: PA SC006165) | |
| 213E00000X Podiatrist (Licence: KY 00375) | |
| 213E00000X Podiatrist (Licence: NY 006416-1) | |
| 213E00000X Podiatrist (Licence: IN 07001142A) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2017-02-07 |