| NPI | 1235182452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO R6679) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS 0416084) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-08-13 |