| NPI | 1588617971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ MA22450) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 096573-1) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-08 |