| NPI | 1851437115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35-04-4388L) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 33708) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |