| NPI | 1255513859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OK 29428) |
| Additional Taxonomies | 2085R0001X (Licence: CA 85308) |
| 2085R0001X (Licence: GU MC-148) | |
| 2085R0001X (Licence: IN 01064419A) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2025-03-16 |