NPI | 1467768259 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171W00000X Contractor (Licence: PA PT 019107) |
Additional Taxonomies | 171W00000X Contractor (Licence: NY PT 028231-1) |
Enumeration Date | 2010-08-31 |
Last Update Date | 2010-08-31 |