| NPI | 1518221704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME147110) |
| Additional Taxonomies | 2086S0129X (Licence: VA 0101280105) |
| 2086S0129X (Licence: CA A172469) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2026-03-03 |