NPI | 1891017000 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PA MD435320) |
Additional Taxonomies | 208D00000X General Practice (Licence: LA MD.014835) |
208D00000X General Practice (Licence: NJ 25MA08478500) | |
Enumeration Date | 2010-02-16 |
Last Update Date | 2010-02-16 |