| NPI | 1730169590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D36652) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101040613) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2007-11-29 |