| NPI | 1073136198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1017678) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP04978) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2024-06-14 |