| NPI | 1801580444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: NJ 25MP00785800) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP785800) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2024-04-17 |