| NPI | 1629168919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07606700) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: NY 226439) |
| 207P00000X Emergency Medicine (Licence: NY 226439-01) | |
| 207P00000X Emergency Medicine (Licence: TX N9240) | |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2022-12-27 |