| NPI | 1124768601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD20740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP05762) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-09-02 |