| NPI | 1467550012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MO 2006009929) |
| Additional Taxonomies | 2085R0001X (Licence: CA 144677) |
| 2085R0001X (Licence: WA 60430276) | |
| 2085R0001X (Licence: ID 12777) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-11-08 |