| NPI | 1316267750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101247857) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC MD034785) |
| 174400000X Specialist (Licence: AL MD27482) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2013-01-09 |