| NPI | 1427162536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR OR MD17046) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA WA MD00034916) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-07-08 |