| NPI | 1598999740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 097836) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA03292300) |
| Enumeration Date | 2009-05-02 |
| Last Update Date | 2009-05-02 |