| NPI | 1205816642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA MD.013222) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 013222) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2010-12-06 |