| NPI | 1407857055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IN 01100327A) |
| Additional Taxonomies | 2085R0001X (Licence: VT 042.0018615) |
| 2085R0001X (Licence: NH 34583) | |
| 2085R0001X (Licence: NY 198294) | |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2026-09-01 |