| NPI | 1053303768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9900860) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD12717) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2024-02-13 |