| NPI | 1952832610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA OH000045) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA PD000036) |
| 174400000X Specialist (Licence: PA OF000040) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |