| NPI | 1609311984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA10578700) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.140700) |
| Enumeration Date | 2016-12-22 |
| Last Update Date | 2021-03-31 |