| NPI | 1982632337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TN DO0000001524) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN DO0000001524) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-09-17 |