| NPI | 1679677678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IL 036091247) |
| Additional Taxonomies | 2085R0001X (Licence: HI MD-14509) |
| 2085R0001X (Licence: MO R5P72) | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2023-02-09 |