| NPI | 1598723272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 191616) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA06811400) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-09-16 |