| NPI | 1215130034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI MD12715) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD429607) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: RI 12715) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2013-08-22 |