| NPI | 1588948392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA09522100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 262840) |
| 208600000X Surgery (Licence: NY 262840-1) | |
| 208600000X Surgery (Licence: PA MD443874) | |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2014-08-28 |