Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1170PT | MD |
NPI | 1619158748 |
---|---|
Provider Name | Stewart J Falk |
First Address | Pikesville, MD 21208-2762 |
Second Address | Pikesville, MD 21208-2762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 16/11/2007 |