| NPI | 1770830697 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 542489111) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 456622101) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2012-08-09 |