| 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 |