| NPI | 1912993718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA09508700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00607800) |
| 207P00000X Emergency Medicine (Licence: VA 0116023725) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2014-06-23 |