| NPI | 1679897003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NM 3654) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM LMT3654) |
| Enumeration Date | 2010-03-14 |
| Last Update Date | 2010-03-14 |