| NPI | 1861066896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: RI MD19611) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05316) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2024-02-01 |