| NPI | 1033566534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: AL MD.42458) |
| Additional Taxonomies | 2085R0001X (Licence: AL 42458) |
| 2085R0001X (Licence: GA 98422) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2025-08-13 |