| NPI | 1053330647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA07733700) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 25MA077337000) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-08-22 |