NPI | 1255627501 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 193400000X Single Specialty (Licence: NJ 25MA09903400) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 000000000000) |
Enumeration Date | 2011-06-24 |
Last Update Date | 2018-11-02 |