| NPI | 1235491440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OH 35.142640) |
| Additional Taxonomies | 2085R0001X (Licence: PA MD465818) |
| 2085R0001X (Licence: TX BP10044138) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2021-09-09 |