| NPI | 1215909593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX P1751) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 2000155782) |
| 174400000X Specialist (Licence: KS 04-28677) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-05-04 |