| NPI | 1528151305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: PA MD429908) |
| Additional Taxonomies | 2085R0001X (Licence: NH NHLT2493) |
| 2085R0001X (Licence: DE C1-0009854) | |
| 2085R0001X (Licence: MI 4301100848) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-07-27 |