| NPI | 1396002614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 18898) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA60257304) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2012-04-12 |