| NPI | 1639796642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD484854) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP05100) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2024-10-23 |