| NPI | 1558479691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA C35222) |
| Additional Taxonomies | 171W00000X Contractor (Licence: CA C35222) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2007-07-24 |