| NPI | 1447512793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 563143111) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 563144111) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2012-06-12 |