| NPI | 1942284724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX D7296) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G24491) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2025-10-05 |