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 |