| NPI | 1467543850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NM MD2009-0745) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 157671) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2014-04-15 |