| NPI | 1326181447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MA00020384) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR 11816) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |