| NPI | 1134126220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IL 036168260) |
| Additional Taxonomies | 2085R0001X (Licence: MN 70262) |
| 2085R0001X (Licence: TX H8803) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2025-03-04 |