| NPI | 1326553314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZA2600X Specialist/Technologist, Other, Art, Medical (Licence: ID 1) |
| Additional Taxonomies | 246ZA2600X Specialist/Technologist, Other, Art, Medical |
| 246ZA2600X Specialist/Technologist, Other, Art, Medical | |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2017-12-12 |