| NPI | 1659354488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 219583) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD08026) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2025-07-01 |