| NPI | 1457383366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA A71886) |
| Additional Taxonomies | 2086S0129X (Licence: SD 16747) |
| 2086S0129X (Licence: ND 22037) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2026-05-04 |