| NPI | 1942658372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 282308) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP03652) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2020-06-28 |