| NPI | 1699704957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: NY 022705-1) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NJ QA00813400) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2013-07-30 |