| NPI | 1386693026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KS 0425086) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO R9N48) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2019-09-04 |