| NPI | 1720585094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA11818900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101271496) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2025-07-01 |