| NPI | 1558714923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA 60893) |
| Additional Taxonomies | 171W00000X Contractor (Licence: CA 60893) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2016-07-20 |