| NPI | 1942207733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36-00-2513) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 236) |
| 213E00000X Podiatrist (Licence: PA SC-00-3181) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2019-02-21 |