| NPI | 1568570661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA05344400) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 193438-1) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2010-12-03 |