| NPI | 1215671367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID 3681108) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP05775) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2026-07-01 |