| NPI | 1245214238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA11493100) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A86002) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2025-10-30 |