| NPI | 1982646816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 209285) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA06784200) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2010-06-11 |