| NPI | 1134327489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MD00024355) |
| Additional Taxonomies | 171W00000X Contractor (Licence: WA MDooo24355) |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2007-07-09 |