| NPI | 1124000443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A107455) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD427239) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2022-11-07 |