| NPI | 1144380684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: TX K6337) |
| Additional Taxonomies | 2085R0001X (Licence: AZ 29277) |
| 2085R0001X (Licence: CA G86424) | |
| 2085R0001X (Licence: IL 036-104732) | |
| 2085R0001X (Licence: IA 34168) | |
| 2085R0001X (Licence: NY 203103) | |
| 2085R0001X (Licence: MN 44487) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2016-09-19 |