| NPI | 1962493585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 239327) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 222913) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA08132300) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2012-02-01 |