| NPI | 1477713204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA OI00000294) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA PS00000315) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2008-06-16 |