| NPI | 1356376958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A304860) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A30486) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-08-04 |