| NPI | 1386185346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA OH000262) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA PO000181) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2017-03-10 |