| NPI | 1285836619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: CA G193306) |
| Additional Taxonomies | 2085R0001X (Licence: PA MD439170) |
| 2085R0001X (Licence: FL ME137894) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2024-04-29 |