| NPI | 1639218829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA PS00000207) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA OI00000306) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2017-09-19 |