| NPI | 1407435928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: WV 37014) |
| Additional Taxonomies | 2085R0001X (Licence: PA MD495607) |
| 2085R0001X (Licence: VA 0101289648) | |
| 2085R0001X (Licence: DC MD600005933) | |
| 2085R0001X (Licence: MD D0107217) | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2026-07-13 |