| NPI | 1053544627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NY 316673) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036.141173) |
| 2086S0129X (Licence: IL 036141173) | |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2023-12-18 |