| NPI | 1033372610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PR 22198) |
| Additional Taxonomies | 2086S0129X (Licence: MD D0071255) |
| 2086S0129X (Licence: MA P-220946) | |
| 2086S0129X (Licence: GA 78805) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2024-07-16 |