| NPI | 1629128384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 142563) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 54528) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-08 |