| NPI | 1760793194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 000053-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 000029-1) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2010-07-01 |