| NPI | 1801988647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: RI DPM00222) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 2162) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2022-02-24 |