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 |