| NPI | 1922429844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA 57181600) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 491380990) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2013-12-18 |