| NPI | 1669508057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 024629) |
| Additional Taxonomies | 174400000X Specialist (Licence: RI MD05796) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-08 |