| NPI | 1073346748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 0000000) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA067234) |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2025-10-15 |