| NPI | 1275587024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NY 1452341) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 44570) |
| 2086S0129X (Licence: NJ MA44570) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2013-08-21 |