| NPI | 1457703894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TN 5831) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 21317) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-07-11 |