| NPI | 1710926134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 220929) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME90834) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2010-06-11 |