| NPI | 1720492515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IA 005108) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 070019829) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |