| NPI | 1144487562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NC 2008-00963) |
| Additional Taxonomies | 2086S0129X (Licence: TX T0964) |
| 2086S0129X (Licence: CA A85121) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2026-07-07 |