| NPI | 1710202122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA08889000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT196382) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2014-11-24 |