| NPI | 1528487089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NY 345605) |
| Additional Taxonomies | 2085R0001X (Licence: NJ 25MA10129400) |
| 2085R0001X (Licence: CA C197416) | |
| 2085R0001X (Licence: MA 281113) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2026-08-11 |