| NPI | 1730447509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA FR3865257) |
| Additional Taxonomies | 2086S0129X (Licence: PA MD452994) |
| 2086S0129X (Licence: WV 29770) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2025-04-04 |