| NPI | 1962437392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 257161) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G054026) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2013-09-19 |