| NPI | 1568497592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 218109) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD11618) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-01-23 |