| NPI | 1144337619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR MD13692) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00034604) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-18 |