| NPI | 1760775910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 60 279124) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP02220) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2015-06-29 |