| NPI | 1205869146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 192624) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 55700) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-02-07 |