| NPI | 1386795664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 222599-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA07711400) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |