| NPI | 1114039849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA MD-55087) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA07541200) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-07-02 |