| NPI | 1376926063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 304276) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MB10481300) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2025-01-30 |