| NPI | 1437187598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: WA MD00023966) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 23966) |
| 2086S0129X (Licence: PA MD03825IL) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2016-09-30 |