| NPI | 1205939998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 176972-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA58803) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2021-04-02 |