| NPI | 1093116360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 759085131) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 759084131) |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2014-09-05 |