| NPI | 1487659843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD012579) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME80465) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2015-01-06 |