| NPI | 1265666465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: SC 31875) |
| Additional Taxonomies | 2080H0002X (Licence: DC 041549) |
| 2080H0002X (Licence: MD D77350) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2015-07-09 |