| NPI | 1104355874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI LP03961) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD18214) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-12-01 |