| NPI | 1871587212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D0024470) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD60569954) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2018-10-04 |