| NPI | 1205845468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD0000027300) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS 13794) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2024-09-25 |