| NPI | 1750813960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MO 2022005512) |
| Additional Taxonomies | 2085R0001X (Licence: IL 036159841) |
| 2085R0001X (Licence: KS 04-46207) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-09-29 |