| NPI | 1376524868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: RI 10215) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 226505) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2008-02-13 |