| NPI | 1629308762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 213.000220) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 211.000186) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2019-08-22 |