NPI | 1154336808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: LA 13608R) |
Additional Taxonomies | 174400000X Specialist (Licence: CT 036769) |
Enumeration Date | 2006-07-30 |
Last Update Date | 2007-07-08 |