| NPI | 1386238210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB11969000) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NJ 25MB11969000) |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2025-09-03 |