| NPI | 1497748925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D0001989) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD C1-0005858) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2018-10-03 |