| NPI | 1609238005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 19449) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 298691) |
| 207P00000X Emergency Medicine (Licence: NJ 25MB10529600) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2021-12-18 |