| NPI | 1043204290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: RI 09027) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM MB20110055) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2011-02-25 |