| NPI | 1750525432 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 22055)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25ma08647900)  | 
| Enumeration Date | 2009-04-27 | 
| Last Update Date | 2023-09-22 |