| NPI | 1295702934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 030997) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD0000048233) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2014-01-23 |