| NPI | 1295727758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA06150500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA06150500) |
| 208D00000X General Practice (Licence: NJ 25MA06150500) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2009-01-30 |