| NPI | 1174852834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: IN 0501024A) |
| Additional Taxonomies | 171W00000X Contractor (Licence: IL 1631979) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2009-12-09 |