| NPI | 1376848366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: RI LPR00098) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N006453-1) |
| 213E00000X Podiatrist (Licence: PA SC006519) | |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2013-12-11 |