| NPI | 1588715577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 011800) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 46TR00432300) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |