| NPI | 1932200482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB07651600) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ME DO2108) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-12-15 |