| NPI | 1912962028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX L9092) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A85084) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2021-06-23 |