| NPI | 1396744934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X (Licence: MD D0054114) |
| Additional Taxonomies | 2084N0600X (Licence: DC MD034282) |
| 2084N0600X (Licence: TX U0717) | |
| 2084N0600X (Licence: MI EMC0002637) | |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2023-06-08 |