| NPI | 1578628814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X (Licence: MD D62651) |
| Additional Taxonomies | 2084N0600X (Licence: DC MD035375) |
| 2084N0600X (Licence: VA 0101237584) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2021-06-27 |