| NPI | 1407869936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D0064145) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 31716) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |