| NPI | 1639438013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 281642-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA09686400) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 25MA09686400) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2024-05-08 |