| NPI | 1376739037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: TX V9429) |
| Additional Taxonomies | 2085R0001X (Licence: CA A87841) |
| 2085R0001X (Licence: MD D68806) | |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2025-09-03 |