| NPI | 1538515606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD16625) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 267369) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2021-04-01 |