| NPI | 1710506456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ID P-291) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: RI LPR00214) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-12-19 |