| NPI | 1518989516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 116475) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 108611) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-09-20 |