| NPI | 1780687889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: CO DR.0026605) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 26605) |
| 2085R0001X (Licence: NM 79-137) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-08-22 |