| NPI | 1710418264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA PO000005) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA OH000010) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2017-03-27 |