| NPI | 1497173017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME157128) |
| Additional Taxonomies | 2086S0129X (Licence: MI EMC0003827) |
| 2086S0129X (Licence: GA 88400) | |
| 2086S0129X (Licence: MO 2024029893) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2025-05-12 |