| NPI | 1194787457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA md00023805) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 34644) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2007-07-30 |