| NPI | 1992767750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX N4654) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS 0419853) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2014-01-08 |