| NPI | 1922029701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 198494) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 53412) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2019-02-07 |