| 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 |