| NPI | 1780886895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MD00041349) |
| Additional Taxonomies | 174400000X Specialist (Licence: WI 43473-020) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2008-11-25 |