| NPI | 1407118359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IL 126.061489) |
| Additional Taxonomies | 2085R0001X (Licence: MN 62186) |
| 2085R0001X (Licence: IL 036148380) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2021-12-25 |