| NPI | 1154741379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: LA 880039) |
| Additional Taxonomies | 171W00000X Contractor (Licence: LA 49250) |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2014-04-27 |