| NPI | 1740205921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: GA 99225) |
| Additional Taxonomies | 2085R0001X (Licence: IN 01061833A) |
| 2085R0001X (Licence: GU M-1915) | |
| 2085R0001X (Licence: AL MD.51250) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-06-30 |