| NPI | 1225228034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NV 13164) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A95522) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2016-04-14 |