| NPI | 1992806830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR OR MD13092) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA WA MD00035024) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |