| NPI | 1003001462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: TX P0942) |
| Additional Taxonomies | 2085R0001X (Licence: FL ME112431) |
| 2085R0001X (Licence: GA 72501) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2024-05-31 |