| NPI | 1215017611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: DC 1255) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD d0025028) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-05-11 |