NPI | 1407800949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0001X (Licence: PA MD471544) |
Additional Taxonomies | 2085R0001X (Licence: NJ 25MA07269500) |
2085R0001X (Licence: NY 1905341) | |
Enumeration Date | 2006-05-20 |
Last Update Date | 2020-11-23 |