| NPI | 1396030102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA A165653) |
| Additional Taxonomies | 2086S0129X (Licence: MT 76915) |
| 2086S0129X (Licence: MN 62145) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2025-02-21 |