| NPI | 1134487135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD15794) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: RI MD15794) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD15794) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2023-10-10 |