| NPI | 1427547280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05555) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 68041) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2022-07-07 |