| NPI | 1932294246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X (Licence: OH 36002932N) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 00316) |
| 213E00000X Podiatrist (Licence: OH 36002932N) | |
| 213ES0131X (Licence: WV 00316) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-09-11 |