| NPI | 1780630749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 200600954) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 430618) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2012-02-01 |