| NPI | 1841336138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: ID MC0957) |
| Additional Taxonomies | 2086S0129X (Licence: CA G34124) |
| 2086S0129X (Licence: AZ 59047) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-07-23 |