| NPI | 1194702928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: AL 40648) |
| Additional Taxonomies | 2085R0001X (Licence: TX M5658) |
| 2085R0001X (Licence: MI 4301056847) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-04-26 |