| NPI | 1346235819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: AK 5909) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA07510200) |
| 207P00000X Emergency Medicine (Licence: AK 4037) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NJ 25MA07510200) | |
| 208D00000X General Practice (Licence: NJ 25MA07510200) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2023-12-19 |