| NPI | 1215943089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G134589) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 210647) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-05-22 |