| NPI | 1326149634 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: RI DPM00201) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: RI DPM00201) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-06-23 |