| NPI | 1316262363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: PA MD466047) |
| Additional Taxonomies | 2085R0001X (Licence: NJ 25MA12019900) |
| 2085R0001X (Licence: VA 0101280527) | |
| 2085R0001X (Licence: NY 327352) | |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2025-07-24 |