| NPI | 1306088075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 11005) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA00019710) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2009-03-30 |