| NPI | 1740296086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: RI DPM00262) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 1944) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-02-13 |