| NPI | 1356604656 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 309048091) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 648065) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2012-06-21 |