| NPI | 1265456115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: VA 0101269397) |
| Additional Taxonomies | 2086S0129X (Licence: WI 52267) |
| 2086S0129X (Licence: OH 35129583) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-07-31 |