| NPI | 1992758007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NJ 25MB05783900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ MB57839) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-06-28 |