| NPI | 1366890279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 22267) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101269033) |
| 207P00000X Emergency Medicine (Licence: TN 60918) | |
| 207P00000X Emergency Medicine (Licence: RI LP03719) | |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2023-06-05 |