| NPI | 1174605323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MD D57830) |
| Additional Taxonomies | 2086S0129X (Licence: VA 0101279401) |
| 2086S0129X (Licence: PA MD461523) | |
| 2086S0129X (Licence: NY 207424) | |
| 2086S0129X (Licence: IL 036166439) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2024-08-12 |