| NPI | 1114374048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME154286) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP03683) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2023-06-23 |