| NPI | 1225265861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NJ 25MA10016700) |
| Additional Taxonomies | 2086S0129X (Licence: PA MD444812) |
| 2086S0129X (Licence: NY 284362) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2025-02-21 |