| NPI | 1073019758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 68717) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD17583) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2026-03-16 |