| NPI | 1295774453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: FL ME157839) |
| Additional Taxonomies | 2085R0001X (Licence: GA 061831) |
| 2085R0001X (Licence: TX L5697) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2026-01-08 |