| NPI | 1578509733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: ND 7230) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 38105) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2010-08-09 |