| NPI | 1801004155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA10293300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 061648) |
| 208D00000X General Practice (Licence: GA 061648) | |
| 208D00000X General Practice (Licence: NJ 25MA10293300) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-05-21 |