| NPI | 1740263953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 24347) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00031165) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2016-03-30 |