| NPI | 1487648283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA05474800) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA05474800) |
| 208D00000X General Practice (Licence: NJ 25MA05474800) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2010-11-09 |