| NPI | 1821293952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: SD 8484) |
| Additional Taxonomies | 2085R0001X (Licence: IA 40170) |
| 2085R0001X (Licence: WV 27117) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2022-12-13 |