| NPI | 1730426644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35.040170) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL me94656) |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2013-01-11 |