| NPI | 1366421653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AR C-6484) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR C6484) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2018-03-12 |