| NPI | 1255786240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: RI DPM00361) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: RI LPR00163) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2019-05-08 |