| NPI | 1538269725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR OR MD11809) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA WA MD00018494) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |