| NPI | 1851635072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 684875121) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 684874121) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |