| NPI | 1629312061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 266883) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD051742L) |
| 174400000X Specialist (Licence: NC 25834) | |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2012-11-26 |