| NPI | 1316093081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: NC 2010-00402) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 2010-00402) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2025-08-11 |