| NPI | 1912181215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD d46443) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA g067028) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2007-12-21 |