| NPI | 1326257114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A43041) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME171111) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2025-05-30 |