| NPI | 1104811785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 187371) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA06514700) |
| 207P00000X Emergency Medicine (Licence: NY 187371) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2016-01-20 |