| NPI | 1295078558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 325880) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 2850541) |
| 207P00000X Emergency Medicine (Licence: NJ 25MB09944900) | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2021-09-29 |