| NPI | 1841299864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: TX H4024) |
| Additional Taxonomies | 2085R0001X (Licence: AR N-7404) |
| 2085R0001X (Licence: IN 01077040Z) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2021-06-30 |