| NPI | 1003836305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D23145) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC 9171) |
| 174400000X Specialist (Licence: VA 0101027840) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |