| NPI | 1689100273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: MI AS500012029) |
| Additional Taxonomies | 171W00000X Contractor (Licence: MI AS630066532) |
| 171W00000X Contractor (Licence: MI AS630079486) | |
| 171W00000X Contractor (Licence: MI AS500363588) | |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2019-07-29 |