| NPI | 1518923796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: PA MD025728E) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NJ 25MA05089200) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2014-10-22 |