| NPI | 1639312341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA PT - 37846) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 21993-1) |
| 174400000X Specialist (Licence: MA 18444) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2016-03-03 |