NPI | 1306221916 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0001X (Licence: FL ME172814) |
Additional Taxonomies | 2085R0001X (Licence: NY P96803) |
2085R0001X (Licence: IN 01077124A) | |
2085R0001X (Licence: OH 35.138513) | |
Enumeration Date | 2015-07-24 |
Last Update Date | 2025-06-03 |