| NPI | 1104129204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA09176700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 256137) |
| Enumeration Date | 2010-12-10 |
| Last Update Date | 2019-04-11 |