| NPI | 1326144841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: PA MD421400) |
| Additional Taxonomies | 2085R0001X (Licence: CA A96168) |
| 2085R0001X (Licence: NJ 25MA08173600) | |
| 2085R0001X (Licence: DE C1-0010053) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2023-09-12 |