NPI | 1720038227 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 174400000X Specialist (Licence: MO 113234) |
Additional Taxonomies | 174400000X Specialist (Licence: KS 04-28188) |
Enumeration Date | 2006-05-12 |
Last Update Date | 2021-01-15 |