| NPI | 1740234913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: AL 13462) |
| Additional Taxonomies | 2085R0001X (Licence: LA 350798) |
| 2085R0001X (Licence: OH 35C.003898) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2026-05-18 |