| NPI | 1679763247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA PS 60145968) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA OI00000477) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2012-05-10 |