| NPI | 1871559500 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: RI DPM 206) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: RI DPM 206) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2008-02-05 |