| NPI | 1619946738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NC NC 2005-00329) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC SC TL27619) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2015-06-09 |