| NPI | 1184642837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 153872) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 1538721) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2011-01-05 |