| NPI | 1407834112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: WI 44633) |
| Additional Taxonomies | 2085R0001X (Licence: MN 32200) |
| 2085R0001X (Licence: ND 5883) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2025-09-24 |