| NPI | 1164689956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA08567300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 61912) |
| 207P00000X Emergency Medicine (Licence: NY 246507-01) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2026-04-02 |