| NPI | 1205168234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: OR 8024) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA 00016730) |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2010-12-21 |