| NPI | 1083645386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 159805) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 29699) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2018-12-12 |