| NPI | 1780177758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1013248) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD17509) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-03-27 |