| NPI | 1619927720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO 2001023021) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS 04-27485) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-01-15 |