Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC001064L | PA |
NPI | 1578591970 |
---|---|
Provider Name | Michael Jude Loquasto |
First Address | Whitehall, PA 18052-5836 |
Second Address | Whitehall, PA 18052-5836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 25/06/2009 |