| NPI | 1700880788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO MDR6627) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR R3317) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2007-07-08 |