| NPI | 1104866037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 190231) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA06924400) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-08 |