| NPI | 1013950567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX m9170) |
| Additional Taxonomies | 2086S0129X (Licence: FL ME82783) |
| 2086S0129X (Licence: OH 35.072293) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2022-07-21 |