| NPI | 1184998239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA PS60182182) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA OI60180848) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2012-03-06 |