| NPI | 1285621664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX G2379) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR R3021) |
| 174400000X Specialist (Licence: LA L#014100) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-03-07 |