| NPI | 1740591015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI DO00744) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP02071) |
| 207Q00000X Family Medicine (Licence: MA 254757) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2020-08-06 |