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 |