| NPI | 1558626820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 511232111) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 504042111) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2012-07-11 |