| NPI | 1295035608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 1744R1102X Specialist Research Study |
| 374K00000X Religious Nonmedical Practitioner | |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2010-11-01 |