| NPI | 1730389016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MN 82311) |
| Additional Taxonomies | 2085N0700X (Licence: AL L2849) |
| 2085N0700X (Licence: IL 036165020) | |
| 2085N0700X (Licence: AR E-12127) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2026-09-10 |