| NPI | 1225386824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 82630) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA12139100) |
| 208D00000X General Practice (Licence: GA 82630) | |
| 208D00000X General Practice (Licence: NY 334634) | |
| 208D00000X General Practice (Licence: PA MD485881) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2025-09-03 |