Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 9418 | RI |
NPI | 1205881984 |
---|---|
Provider Name | Robert Michael Risica |
First Address | Wakefield, RI 02879 |
Second Address | Wakefield, RI 02879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9020447 | (05) | RI |
F54934 | (02) |