| NPI | 1770587164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35.092769) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036061482) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2014-08-08 |