| NPI | 1821244724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: NY 254073) |
| Additional Taxonomies | 2088P0231X (Licence: WA MD60282107) |
| 2088P0231X (Licence: MD D0077591) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2023-07-05 |