| NPI | 1023068350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MS 09371) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA MD.013940) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2023-03-07 |