NPI | 1851839781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: NY 759759131) |
Additional Taxonomies | 174400000X Specialist (Licence: NY 790721131) |
Enumeration Date | 2017-02-12 |
Last Update Date | 2017-02-12 |