| NPI | 1235429507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: CA A123801) |
| Additional Taxonomies | 2085R0001X (Licence: TX BP1-0039560) |
| 2085R0001X (Licence: MA 270290) | |
| 2085R0001X (Licence: GA 081479) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2024-02-07 |