| NPI | 1144541681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NV 24384) |
| Additional Taxonomies | 2086S0129X (Licence: IA MD-44504) |
| 2086S0129X (Licence: PA MT197379) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2026-04-01 |