| NPI | 1053692921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other (Licence: TX ATP4344) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: TX 1008601) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2011-09-06 |