| 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 |