| NPI | 1497758734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 183122) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 037168) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2014-12-11 |