| NPI | 1366880130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI DO00831) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP02941) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2025-11-28 |