| NPI | 1861558918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 184330-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA06442200) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2016-03-09 |