NPI | 1912004268 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246Z00000X Specialist/Technologist, Other (Licence: MD A0000067) |
Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: OH AT000164) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2012-06-10 |