| NPI | 1053706721 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 287090-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA12380300) |
| 207Q00000X Family Medicine (Licence: NY 287090-1) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2025-02-11 |