| NPI | 1629465208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME DO3075) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: RI DO00947) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: ME DO3075) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: CT 83039) | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2026-08-13 |