| NPI | 1982019907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003789) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01644) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006541) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2023-11-03 |