| NPI | 1467451757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB07371800) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 1727) |
| 207P00000X Emergency Medicine (Licence: VA 0102201110) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2020-04-06 |