| NPI | 1578128989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI MD20515) |
| Additional Taxonomies | 207PH0002X Emergency Medicine, Hospice and Palliative Medicine (Licence: RI MD20515) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2026-01-20 |