| NPI | 1073638870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: SC 61243) |
| Additional Taxonomies | 2088P0231X (Licence: NY 272913-1) |
| 2088P0231X (Licence: OH 35.086578) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2018-09-06 |