| NPI | 1336662196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: CT 72200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04098) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 64837) | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2023-02-03 |