| NPI | 1265927438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX U2956) |
| Additional Taxonomies | 2086S0129X (Licence: PA FN6766159) |
| 2086S0129X (Licence: PA MD494931) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2026-06-09 |