| NPI | 1366696957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 250915) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA08504000) |
| Enumeration Date | 2008-11-09 |
| Last Update Date | 2010-01-11 |