| NPI | 1609283498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 66185 National) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ JE12257) |
| 174400000X Specialist (Licence: NJ 26994) | |
| 174400000X Specialist (Licence: NJ 2622) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2014-07-14 |