| NPI | 1194949867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD037176Y) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 185653-1) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |