| NPI | 1669409678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: ID MC-0034) |
| Additional Taxonomies | 174400000X Specialist (Licence: WY 5572A) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2019-07-01 |