| NPI | 1578613568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA 043053-L) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25ma0817880) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |