| NPI | 1942206875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36-001383) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: OH 36-001383) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: OH 36-001383) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36-001383) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2008-03-20 |