| NPI | 1740425362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL PT 24582) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA PT35046) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2009-03-09 |