| NPI | 1447276704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 132248) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA03547500) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-05-09 |