| NPI | 1255704151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other (Licence: AZ 630107010414296) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: AZ T033994) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2015-11-02 |