| NPI | 1780709899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NM 1462) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX MT007176) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |