| NPI | 1568564136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 161145) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA069408) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2012-10-05 |