| NPI | 1649096421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156F00000X Technician/Technologist (Licence: FL 91698) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| Enumeration Date | 2024-11-26 |
| Last Update Date | 2024-11-26 |