| NPI | 1811456270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: RI DPM00372) |
| Additional Taxonomies | 211D00000X Assistant, Podiatric |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2022-09-07 |