| NPI | 1669842233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101259018) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0014729) |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2015-09-25 |