| NPI | 1659365781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL AL 3939) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA RT001346A) |
| Enumeration Date | 2005-09-05 |
| Last Update Date | 2015-01-12 |