| NPI | 1831148832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 183333) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD422048) |
| 174400000X Specialist (Licence: CT 043968) | |
| 174400000X Specialist (Licence: MD D0062210) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2012-08-31 |