NPI | 1710051909 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: NY 166344-1) |
Additional Taxonomies | 174400000X Specialist (Licence: NY 166344) |
Enumeration Date | 2006-11-20 |
Last Update Date | 2023-07-03 |