| NPI | 1588736144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G71053) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 44372) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-12-09 |