| NPI | 1215091376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ MA60340) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA06034000) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2008-05-20 |