| NPI | 1801464250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI LP05774) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2022-06-20 |