| NPI | 1013900281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IL 036164254) |
| Additional Taxonomies | 2085R0001X (Licence: CO CDRH.0040881) |
| 174400000X Specialist (Licence: CO 40881) | |
| 2085R0001X (Licence: CA C154753) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2025-09-29 |