| NPI | 1184782021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 207758) |
| Additional Taxonomies | 208D00000X General Practice (Licence: RI MD19361) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2026-06-23 |