| NPI | 1649253329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NV 13922) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A45707) |
| 2085R0001X (Licence: CA A45707) | |
| Enumeration Date | 2005-11-27 |
| Last Update Date | 2014-12-01 |