| NPI | 1730262791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: DC MD12895) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0026354) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-09 |