| NPI | 1457317190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT P00337) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: RI DPM00211) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2011-04-04 |