| NPI | 1811991797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 193400000X Single Specialty (Licence: NE 22920) |
| Additional Taxonomies | 174400000X Specialist (Licence: OK 23469) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2017-11-29 |