| NPI | 1487237368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT222400) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2022-06-02 |