| NPI | 1033320213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: OH 35C.001197) |
| Additional Taxonomies | 2086S0129X (Licence: DC MD210002490) |
| 2086S0129X (Licence: VA 0101272925) | |
| 2086S0129X (Licence: PA MD474815) | |
| 2086S0129X (Licence: MD MD71662) | |
| Enumeration Date | 2007-05-27 |
| Last Update Date | 2024-12-20 |