| NPI | 1679100101 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI DO01392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP05013) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-08-26 |