| NPI | 1962491225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IA 34119) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036096127) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2007-10-29 |