| NPI | 1073714358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA C203948) |
| Additional Taxonomies | 2086S0129X (Licence: CT 044485) |
| 2086S0129X (Licence: LA 201525) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2025-11-06 |