| NPI | 1538210042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 275819) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 227693) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2023-05-19 |