| NPI | 1659365450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA06434900) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA06434900) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2008-02-01 |