| NPI | 1326279605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G84673) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G8473) |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2022-02-11 |