| NPI | 1598745358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D25388) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101038048) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2016-12-23 |