| NPI | 1336404722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 032.0133795) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI DO 00779) |
| 207Q00000X Family Medicine (Licence: NH 17036) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: VT 032.0133795) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP02581) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2022-09-12 |