| NPI | 1033322219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OH 57.009376) |
| Additional Taxonomies | 2085R0001X (Licence: IL 036119808) |
| 2085R0001X (Licence: IA MD-44303) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2017-06-07 |