| NPI | 1245280858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME99122) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 26567) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2012-10-01 |