NPI | 1316099609 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 174400000X Specialist (Licence: PA MD051049L) |
Additional Taxonomies | 174400000X Specialist (Licence: NJ MA47438) |
Enumeration Date | 2007-01-17 |
Last Update Date | 2007-07-08 |