| NPI | 1649502949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD0000031924) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 31924) |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2015-08-25 |