| NPI | 1669631230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OH 35097034) |
| Additional Taxonomies | 2085R0001X (Licence: IL 125051283) |
| 2085R0001X (Licence: MI 5315052463) | |
| Enumeration Date | 2008-06-08 |
| Last Update Date | 2023-11-03 |