NPI | 1386647295 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: CA c53447) |
Additional Taxonomies | 174400000X Specialist (Licence: GA 033602) |
Enumeration Date | 2005-05-24 |
Last Update Date | 2018-04-27 |