| NPI | 1679065197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 291239) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP04303) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2022-06-15 |