| NPI | 1073556080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D41839) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101239821) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-11-29 |