| NPI | 1568415792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 28663) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 32282) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2015-10-27 |