| NPI | 1154391654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KS 0425133) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO R4N00) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2014-09-25 |