| NPI | 1518942283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G53599) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD17064) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2023-10-19 |