| NPI | 1700022746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: CT 008095) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 030946) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2008-12-22 |