| NPI | 1710399589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI MD16801) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 283419) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2023-12-19 |