| NPI | 1821084583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD038372E) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA04943100) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2013-02-06 |