| NPI | 1205099447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A103810) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 254223) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA09003300) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2024-03-17 |