| NPI | 1487626768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO 2002010265) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS 04-27966) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-02-09 |