| NPI | 1699742551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA06750200) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA067502) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2014-01-21 |