| NPI | 1780858217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 44120) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA03779900) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2022-10-05 |