NPI | 1255359956 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0001X (Licence: FL ME125782) |
Additional Taxonomies | 2085R0001X (Licence: ND 6730) |
2085R0001X (Licence: MN 44163) | |
Enumeration Date | 2006-07-18 |
Last Update Date | 2025-05-08 |