| NPI | 1760478242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 39914) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 97608) |
| 174400000X Specialist (Licence: PA MD-033209E) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2025-08-05 |