| NPI | 1699967232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X (Licence: NJ 25MB07835500) |
| Additional Taxonomies | 2084P0805X (Licence: MD H0071081) |
| 2084P0805X (Licence: AZ 006211) | |
| 2084P0805X (Licence: DE C2-0009060) | |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2018-03-17 |