| NPI | 1871695833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 54594) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD06279) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2016-08-31 |