| NPI | 1518053024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME106236) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 00026429) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2014-03-29 |