| NPI | 1891743159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35.132964) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 23024) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-11-03 |