NPI | 1033104831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 202K00000X (Licence: MO 2004025488) |
Additional Taxonomies | 174400000X Specialist (Licence: MO 2004025488) |
Enumeration Date | 2005-09-18 |
Last Update Date | 2020-02-19 |