| NPI | 1437415684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: DE C1-0013639) |
| Additional Taxonomies | 2086S0129X (Licence: NY 273645) |
| 2086S0129X (Licence: NY 273645-1) | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2020-06-30 |