| NPI | 1124512017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 291228) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP04434) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2022-06-25 |