| NPI | 1841242013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: AZ 35564) |
| Additional Taxonomies | 2086S0129X (Licence: LA MD.08793R) |
| 2086S0129X (Licence: MN 61146) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-04-28 |