| NPI | 1891729976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: RI DPM00225) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT 000428) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2008-07-20 |