| NPI | 1699864389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: RI DPM203) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: RI DPM00203) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2013-09-13 |