| NPI | 1306120993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB10221200) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00267400) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-10-01 |
| Last Update Date | 2018-04-17 |