| NPI | 1750568374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: RI DPM00325) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: RI LPR00069) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 2348) | |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2009-09-28 |