| NPI | 1366602732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA OI00000320) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA PS00000340) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |