| NPI | 1629465208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: ME DO3075) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI DO00947) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2021-01-13 |