| NPI | 1144264201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: PA MD479238) |
| Additional Taxonomies | 2085R0001X (Licence: WI 43017) |
| 2085R0001X (Licence: OR MD27107) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-11-08 |