| NPI | 1477583482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MS 17620) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35.081298) |
| 174400000X Specialist (Licence: TX M0335) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-07-08 |