| NPI | 1467815779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 4358) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA VET007317) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2020-10-22 |