| NPI | 1760452973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD038845E) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA05883400) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2011-03-15 |