| NPI | 1003178419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 1787040) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 560370051) |
| 174400000X Specialist (Licence: NY 743030) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2012-06-12 |