| NPI | 1427342716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: NJ 70656) |
| Additional Taxonomies | 171W00000X Contractor (Licence: VA 231455367) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2011-06-03 |