| NPI | 1316067846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: NV B01660) |
| Additional Taxonomies | 111NR0400X (Licence: TX 7836) |
| 111NR0400X (Licence: LA 1767) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2018-02-28 |