| NPI | 1932738978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TN DPM944) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 59.000849) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2023-05-23 |