| NPI | 1205377561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 309574) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA11189700) |
| Enumeration Date | 2017-03-19 |
| Last Update Date | 2023-02-05 |