| NPI | 1275082406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MO 2015015579) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 3239) |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2016-09-29 |