| NPI | 1588622070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: MA 46148) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MA 46148) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2016-02-02 |