| NPI | 1508846668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OK 47270) |
| Additional Taxonomies | 2085R0001X (Licence: CO 38130) |
| 2085R0001X (Licence: HI MD23123) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2026-02-04 |