| NPI | 1518900257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD036208) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 50061) |
| 174400000X Specialist (Licence: AR E-5830) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2023-03-07 |