| NPI | 1962089904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36.004138) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.004138) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-05-14 |