| NPI | 1780734657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME 14899) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 4778) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |