| NPI | 1487648762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: KS 04-21153) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 40047) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2012-06-14 |