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 |