| NPI | 1639357148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MICHAEL CAVICCHIO Owner 401-644-3861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: RI DPM 206) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2022-04-13 |