| NPI | 1346421856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: VA 0101250786) |
| Additional Taxonomies | 2086S0129X (Licence: IL 036173662) |
| 2086S0129X (Licence: WV 29811) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2025-09-16 |