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 |