| 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 |