| NPI | 1619900529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101033427) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 31376) |
| 174400000X Specialist (Licence: GA 040530) | |
| 174400000X Specialist (Licence: SC 20090) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |