| NPI | 1710091046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA md00019234) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 3099330-1205) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |