| NPI | 1457441339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: OR MD201655) |
| Additional Taxonomies | 2086S0129X (Licence: MO 113383) |
| 2086S0129X (Licence: KS 0428604) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-05-08 |