| NPI | 1528134517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: TX P9548) |
| Additional Taxonomies | 2085R0001X (Licence: FL ME131331) |
| 2085R0001X (Licence: WA MD60413282) | |
| 2085R0001X (Licence: AK 115368) | |
| 2085R0001X (Licence: TX FD4227559) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2024-03-24 |