| NPI | 1689780108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D0027550) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC MD14379) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2009-09-24 |