| NPI | 1356475131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: GA 013965) |
| Additional Taxonomies | 2085R0001X (Licence: FL ME 37209) |
| 2085R0001X (Licence: TN 40576) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |