| NPI | 1376425611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225500000X Specialist/Technologist (Licence: MD 748773) |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: WV 7132154) |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-07-26 |