| NPI | 1659664860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 61632) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP02130) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2025-03-19 |