| NPI | 1629639976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB12100300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T6586) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: NJ 207PE0004X) | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-04-17 |