| NPI | 1275657462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 1021091) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA OT00002839) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-09 |