| NPI | 1588817654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MD00024890) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 38010) |
| Enumeration Date | 2008-11-02 |
| Last Update Date | 2008-11-02 |