| NPI | 1972162881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 295401) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP04737) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2023-07-24 |