| NPI | 1730246463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: KS 04-36965) |
| Additional Taxonomies | 2085R0001X (Licence: KS T-03795) |
| 2085R0001X (Licence: MN 49536) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2024-10-10 |