| NPI | 1124154992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: KS 14-00052) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 117642) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |