| NPI | 1417159765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI LP01088) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 049975) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2011-06-27 |