| NPI | 1861491110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 161272-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 161272) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2009-03-23 |