| NPI | 1194609776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156F00000X Technician/Technologist |
| Additional Taxonomies | 156F00000X Technician/Technologist (Licence: NY 177513) |
| Enumeration Date | 2025-08-05 |
| Last Update Date | 2025-08-05 |