| NPI | 1154843084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376J00000X Homemaker (Licence: PA 00000000000000000000) |
| Additional Taxonomies | 374K00000X (Licence: PA 00000000000000000000) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2018-03-17 |