| NPI | 1376798090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: IL 160.002570) |
| Additional Taxonomies | 171W00000X Contractor (Licence: MO 120019) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2008-11-21 |