| NPI | 1255708087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC HAS-0531) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA HADS-872) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2015-08-27 |