| NPI | 1366070146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1016386) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD20327) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2024-12-16 |