| NPI | 1871123372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSIA LEPOER Authorized Official 401-453-2001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 261QP1100X Clinic/Center, Podiatric | |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2024-11-03 |