| NPI | 1083616353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA04131700) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 139167-1) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2011-04-15 |