| NPI | 1366714354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KS 04-21049) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO R9H39) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2012-02-06 |