| NPI | 1295713584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AR E-13761) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD0000019275) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2021-01-19 |