| NPI | 1033277108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: AR E-6307) |
| Additional Taxonomies | 2088P0231X (Licence: OH 86246) |
| 2088P0231X (Licence: TX M5656) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2022-10-10 |