| NPI | 1063443810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 028100) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 14273) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-12-13 |