| NPI | 1144210626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA C188080) |
| Additional Taxonomies | 2086S0129X (Licence: WA MD61000627) |
| 2086S0129X (Licence: UT 7290038-1205) | |
| 2086S0129X (Licence: CO DR.0067884) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2024-04-29 |