| NPI | 1184654014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA08145500) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD428043) |
| 207P00000X Emergency Medicine (Licence: NY 241272) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2009-06-01 |