| NPI | 1518942879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NJ 25MA11272200) |
| Additional Taxonomies | 2085R0001X (Licence: IL 036169063) |
| 2085R0001X (Licence: FL ME56738) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2025-10-07 |