| NPI | 1043380629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 15541) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC MD4928) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2021-05-03 |