| NPI | 1780633081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: RI DPM00312) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: RI DPM00312) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: RI DPM00312) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2007-07-08 |