| NPI | 1619197464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: ID M-17371) |
| Additional Taxonomies | 2085R0001X (Licence: MI 4301084303) |
| 2085R0001X (Licence: IA 37709) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2025-07-17 |