| NPI | 1366009706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA LP290552) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI LP04533) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2023-01-15 |