| NPI | 1982712063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA07023300) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD065680L) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2007-07-08 |