| NPI | 1780096495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI MD20055) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 274461) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2026-06-15 |