| NPI | 1871173914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 328124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP05406) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2024-07-25 |