| NPI | 1528069044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB06842300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY C4021) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-06-20 |