| NPI | 1366491482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO R7341) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS 0416998) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2008-08-13 |