| NPI | 1043639081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MI 4301513193) |
| Additional Taxonomies | 2085R0001X (Licence: MA 286909) |
| 2085R0001X (Licence: RI MD17446) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2025-04-11 |