| NPI | 1578504312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 133880) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME 87503) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2010-06-11 |