| NPI | 1104117860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI MD15748) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD451160) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2023-12-01 |