| NPI | 1750590998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: SD 7960) |
| Additional Taxonomies | 2086S0129X (Licence: MO 2023050408) |
| 2086S0129X (Licence: KS 04-48891) | |
| 2086S0129X (Licence: NE 31084) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-09-23 |