| NPI | 1356790711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 763864131) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 763764131) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-06-07 |