| NPI | 1942473269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA08322000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 08322000) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-08-06 |