| NPI | 1639449945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA 00017941) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G31700) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2012-01-03 |