| NPI | 1962728063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL 193400000x) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME24402) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2010-04-14 |