| NPI | 1124084017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 220506) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD11247) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-06-01 |