| NPI | 1346479706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NE 30644) |
| Additional Taxonomies | 2086S0129X (Licence: WI 64901-020) |
| 2086S0129X (Licence: IA MD-44973) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2019-08-02 |