| NPI | 1639143506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL OS 9982) |
| Additional Taxonomies | 2086S0129X (Licence: NC 98-00450) |
| 2086S0129X (Licence: AR E-2739) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2026-10-14 |