| NPI | 1114943461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NM MD2018-0696) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA08012400) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-12-04 |