| 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 |