| NPI | 1356350805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A037865) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 00A378650) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-12-20 |