| NPI | 1730114448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL OS20499) |
| Additional Taxonomies | 2086S0129X (Licence: TN 2205) |
| 2086S0129X (Licence: VA 0102203257) | |
| 2086S0129X (Licence: AZ 011005) | |
| 2086S0129X (Licence: KY TP053) | |
| 2086S0129X (Licence: MI 5101011025) | |
| 2086S0129X (Licence: PA OS010217L) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2025-09-05 |