| NPI | 1497751762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101016485) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 14468) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2014-05-25 |